Early Referral to Nephrological Care and the Uptake of Peritoneal Dialysis. An Analysis of German Claims Data

Isabell Schellartz, Sunita Mettang, Arim Shukri, Nadine Scholten, Holger Pfaff and Thomas Mettang
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Isabell Schellartz: Institute of Health Care Research, Rhineland State Council, LVR-IVF, 51109 Cologne, Germany
Sunita Mettang: Betriebskrankenkasse (BKK) Linde, 65187 Wiesbaden, Germany
Arim Shukri: Institute for Health Economics and Clinical Epidemiology (IGKE), University of Cologne, 50935 Cologne, Germany
Nadine Scholten: Faculty of Human Sciences and Faculty of Medicine, Institute of Medical Sociology Health Services Research and Rehabilitation Science (IMVR), University of Cologne, 50933 Cologne, Germany
Holger Pfaff: Faculty of Human Sciences and Faculty of Medicine, Institute of Medical Sociology Health Services Research and Rehabilitation Science (IMVR), University of Cologne, 50933 Cologne, Germany
Thomas Mettang: Kidney Center Wiesbaden, 65191 Wiesbaden, Germany

IJERPH, 2021, vol. 18, issue 16, 1-10

Abstract: Background: Hemodialysis (HD) and peritoneal dialysis (PD) are medically equivalent alternatives for symptomatic therapy of end-stage renal disease (ESRD). An early referral (ER) of patients with chronic kidney disease (CKD) to a nephrological specialist is associated with a higher proportion of patients choosing PD. Germany historically shows a low PD uptake. This article is the first investigation into the impact of ER on the uptake of PD, using a large German claims database. Methods: Claims data of 4727 incident dialysis patients in 2015 and 2016 were analyzed. Accounting codes for nephrological care and dialysis modalities were identified. Their first documentation was defined as their first encounter with a nephrologist and their first dialysis treatment (HD or PD). ER was determined as receiving nephrological care at least six months before the first dialysis. A multivariate logistic regression model with adjusted odds ratios (AOR) investigates the impact of ER, outpatient dialysis start, age, comorbidities, and sex on the chance for PD. Results: Forty-three percent were referred to the nephrologist six months before their first dialysis (ER). Single tests, as well as the adjusted multivariate logistic regression, highlighted that ER significantly increases the chance for PD. In the multivariate model, the uptake of PD was associated with ER (AOR = 3.05; p < 0.001; 95% CI = 2.16–4.32), outpatient dialysis start (AOR = 0.71; p = 0.044; 95% CI = 0.51–0.99), younger age (AOR = 0.96; p < 0.001; 95% CI = 0.95–0.97), and fewer comorbidities (AOR = 0.85; p < 0.001; 95% CI = 0.44–1.58). Conclusions: ER of patients with CKD to a nephrologist increases PD uptake. It gives both nephrologists and patients enough time for patient education about different treatment options and can contribute to informed decisions about the dialysis treatment.

Keywords: early referral; hemodialysis; peritoneal dialysis; treatment choice; pre-dialysis care; claims data; statutory health insurance (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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